Purpose
To determine the relationship between preoperative patient expectation and postoperative
satisfaction and overall patient-reported outcome (PRO) of patients undergoing hip
arthroscopy for femoroacetabular impingement syndrome.
Methods
Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome completed
the validated Hip Preservation Surgery Expectations Survey (21 questions; 0-100 range),
as well as multiple PROs before surgery. High expectation was defined as an expectation
score greater than 1 standard deviation above the mean. Patients with osteoarthritis,
dysplasia, and those having undergone previous hip surgery were excluded. At 1 year
postoperatively, patient visual analog scale (VAS) satisfaction, VAS pain, and PROs
were assessed. Univariable and multivariate analyses were performed.
Results
One-hundred fifty-three subjects (mean age 34.4 ± 12.6 years, female: 114 [71.3%],
body mass index: 25.9 ± 5.3 kg/m2) participated. The mean expectation score was 84.5 ± 12.3. Significant correlations
between high expectation scores (>96.7) and achieving the minimal clinical important
difference (MCID) for modified Harris Hip Score (mHHS; r = 0.339; P = .043) and patient acceptable symptomatic state (PASS) for Hip Outcome Score-Activities
of Daily Living Subscale (HOS-ADL; r = 0.207; P = .032) were observed. There were no significant correlations between high expectation
scores and preoperative or postoperative PROs or patient satisfaction scores. χ2 analysis demonstrated patients with greater expectations had increased rates of reaching
MCID mHHS (92.3% vs 74.7%; P = .08), PASS mHHS (85.7% vs 69.7%; P = .046), and PASS HOS-ADL (93.8% vs 67.4%; P = .031).
Conclusions
High preoperative expectation is associated with increased rates of MCID/PASS achievement
on mHHS and increased rate of PASS achievement on HOS-ADL. Preoperative expectations
did not have an impact on Hip Outcome Score-Sports Subscale; however, patients with
high preoperative expectations also have a high baseline Hip Outcome Score-Sports
Subscale. In addition, preoperative expectations are not associated with postoperative
VAS satisfaction scores.
Level of Evidence
III; non-randomized cohort, therapeutic.
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Article info
Publication history
Accepted:
June 13,
2019
Received:
December 4,
2018
Footnotes
See commentary on page 3259
The authors report the following potential conflict of interest or source of funding: S.J.N. reports non-financial support from Allosource, other from American Journal of Orthopedics, other from American Orthopaedic Society for Sports Medicine, non-financial support from Arthrex, other from Arthroscopy Association of North America, non-financial support from Athletico, non-financial support from DJ Orthopaedics, non-financial support from Linvatec, non-financial support from Miomed, personal fees from Ossur, non-financial support from Smith and Nephew, personal fees and non-financial support from Springer, and non-financial support from Stryker, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Surgeons Should Not “Underpromise” to “Overdeliver”: High Preoperative Patient Expectations Correlate With Improved Orthopaedic Surgical OutcomesArthroscopyVol. 35Issue 12
- PreviewDespite our understanding of patient-specific, anatomic, and surgical factors that can influence surgical outcomes, there remains a significant amount of variability in patient satisfaction and outcome after any orthopaedic surgical procedure. This variability is in large part due to psychosocial factors. There is a growing volume of literature demonstrating the importance of psychosocial factors to include anxiety, depression, attitudinal factors, expectations, patient-perceived control, self-efficacy, knowledge, and expectations.
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